Broussard, John

Broussard, John is an sole proprietor health care provider with primary practice located at 111 2Nd Ave Ne Ste 1401 , St Petersburg FL 33701-3480. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Broussard, John can be contacted via phone (727) 258-7224.

Contact Information

Primary practice address
111 2Nd Ave Ne Ste 1401 St Petersburg FL 33701-3480
Phone: (727) 258-7224
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X OS12241 Florida
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 0102204383 Virginia

Profile Details

NPI number 1174839161
LBN Legal business name Broussard, John
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 27th, 2010
Last updated Aug 27th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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